HomeMy WebLinkAboutCLE200600013 Legacy Document 2014-06-13g
A.pplic <ation for Zoning Clearance
��RGIN�P
OFFICE USE ONLY
19 Zoning Clearance = $35 CLE # 2- Q<2j�4 — 0001
PLEASE REVIEW ALL 3 SHEETS Check # _jb6 9 Date: /- 19 -040
Receipt # „5606, o Staff:
PARCEL INFORMATION
Tax Map and Parcel: () -� 0600 - ci0 -GCS - 0 Q, ]3 Existing Zoning C,
Parcel Owner: JlauloV
/ q ]vI r,?.- W
Parcel Address: a1 i I � L.,
5 y, vi- j�CityC yo\d-o State VA Zip p��l
(include suite_or floor)_- __________
- -1-N”- - ------------------------------------
----------------------------------------
APPLICANT FORMATION
Who should we call /write concerning this project? DIMfF S CS- LC31 �
Address: 115 WQQ1P5 Ln , 6� 9' - )Q 5 City Y 1-0 {501 State Zip
Office Phone: (q.7::�J) '61 -7- tl 001 Cell #
Fax # X61 i -�}o U E -mail
---------- - - - - -- - - - -- -- - - - - - - -- - -- - -- - - - - - - -- - -- - --
PRIMARY CONTACT - - - -- - -- -- - -- - - -- -- - -- -- -- - - --
Business Name/Type: 'V I v ti i V\*, a Y\ 5 - C b0i V ftl,; -o L- P
Previous Business on this site:
Proposed use: L%, l VYQ c i o-
Circle (if applicable): Fireworks / Christmas Tree
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is
true and accurate to of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature //lr V la�" Printed_ j /V
APPR
- - - 0-- V AL I N-- - F-- O -- - - -- - O --- N ------------------------------------------------------------------------
RMAT T I 1 ------------------------------
[A Approved as proposed [ ] Approved with conditions
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a
site plan.
[ ] This site complies with the site plan as of this date.
ation of compliance with the existing
=O�De ice and/ or urata Needed
Building Official Date
Zoning Official Date i�2 aZ
Other Official Date
---------------------------- - - - - -- - -' -- D -------------------------- ---- - - - - --
Co my of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Applicant Jo complete the following:
D/N
o you have one of the following?
�)-1 Coo -oo- ao -o0�vC3
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate;
G►5 w ay \ps L-Y1 ; ��. ►5, aaq r I
Y/N
Do you have a Floor Plan (sketch or an architectural drawing) that
includes the following, and if so please provide it with the
application?
The total square footage of the use and/or;
The square footage of each room or area of use; r�
Use of each room or area
If using less than the entire structure, note the location within the
structure.
, oning Tech to
Viol ions:
Y /U
If so, List:
riance:
Y/N
f so, List:
V A— • 2662. ° C'J6I
the
Intake to complete the following:
Y
Is QN in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y nK
Wij��� ere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
YtN
Is parcel on private well and septic?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
N
public water and sewer?
Y /
Wil you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
Y /1 N
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Is /
Is th s for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
9/N
f so, List:
SP's:
If /
If so, "
ist:
xeviewer to eom fete the imiowm : q
Square footage of Use: % 1
Y / N
Permitted as: •
Under Section:
Supplementary regulations section:
Parking formula: ✓�` QG� (.� P" &j!;P P�P�
Required spaces: (p7q x ' pi i �c S
Y
/C SOO
Item o be verified in the field:
Inspector Name & Date:
Notes
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